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Friday, February 15, 2013

JAKARTA, 14 February 2013 (IRIN) - Indonesia is seeking to boost its
community mental health services in an effort to end the lockdown and
shackling of thousands of mental health patients.

“The practice of shackling mentally-ill people still exists and
eliminating it is one of our priorities for 2013,” Diah Setia Utami,
director of mental health at the Health Ministry, told IRIN, noting that
the country’s “serious” shortage of mental health professionals has
been one of the biggest obstacles.

The government aims to provide 30 percent of the country’s 9,000
community health clinics and 1,700 general hospitals with staff to
provide basic mental health care by 2014, Utami said.

The Health Ministry estimates 19 million people nationwide have various
mental health disorders, including anxiety and depression, and another
one million have severe psychoses.

Currently, 33 specialized mental health hospitals and 600 psychiatrists
offer public mental health care. “These hospitals are adequately
equipped to treat mental patients, but in the future, patients will be
encouraged to have treatment outside [the] hospital under the care of
families and community caregivers,” Utami added.

The Health Ministry estimates some 18,000 people with mental disorders,
mostly in rural areas and bereft of any mental health services, are
still subjected to `pasung’ (shackling)
to prevent them from attacking others. In villages, people with mental
disorders are typically chained behind their homes, while in cities,
limited space and stigma confine a number of them to small rooms.

Opposition to the practice has grown along with local media reports of
people - at times undiagnosed - wasting away after years in chains.

Yusuf said people still resort to `pasung’ - banned since 1977 - because
they cannot afford mental health care and to escape stigma associated
with mental illness.

A psychiatric consultation costs on average US$25, not including drugs.
The government plans to implement nationwide universal health coverage
in 2014, which is expected to cover most mental health costs.

Nova Rianti Yusuf, a member of a parliamentary health commission, noted
the lack of data and research on `pasung’, with the exception of two
recent studies of 49 shackled mental health patients that showed 90
percent of them had schizophrenia and 70 percent were receiving improper
treatment.

The country’s decentralized health care system accounts for uneven
attention to mental health care across the country’s 34 provinces, said
Utami. “There are some regional governments that pay little or no
attention to mental health and, therefore, allocate little or no
budget.”

But, in some places, there are signs of improvement.

Asmarahadi (one name), a psychiatrist at the state-run Soeharto Heerdjan
mental hospital in Jakarta, said mental health care has improved there
“significantly” over the past 10 years. “People used to call the place a
prison, but now it’s like a hotel - at least a one-star hotel.

The hospital receives 150 patients daily and has a policy of not turning anyone away even if they cannot pay, he said.

“People in Jakarta and its surrounding areas are increasingly aware of
mental problems,” he said. “Mental health care is not expensive and even
atypical, third-generation anti-psychotic drugs are accessible at
affordable prices,” he said.

“Treatment failure is usually caused by a lack of patients’ compliance and family support,” he said.

This is if someone seeks formal medical treatment at all. Large pockets
of the country still believe magic spells cause mental illness, with
families turning to shamans and religious leaders for cures.

WHO plan

Under the 2013-2020 World Health Organization (WHO) global mental health action plan,
80 percent of member countries are expected to update their mental
health policies and laws by 2016, while allocating at least 5 percent of
public health expenses to mental health care by 2020.

It also seeks to decrease the number of beds used for long-term stays in
mental hospitals (which medical studies link to poor treatment and
human rights abuses) by 20 percent by 2020, and increase the
availability of places for community-based residential care and
supported housing.

“The government has the responsibility to provide mental health care for
the poor and it should do so by involving local communities,” said
Yusuf.

The WHO plan also calls for doubling the treatment of severe mental
disorders. Up to 85 percent of such disorders are not currently treated
in low- and middle-income countries,WHO estimates.

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